The summer is a time of increasing outdoor activities and with that comes an increased chance of exposure to insects and in particular ticks. While its possible to be bitten by ticks even in the depths of winter boths ticks and people are more active in the warmer months. This means the summer is a time when they are more likely to come into contact with each other so this is a good time to go over some of the illnesses that ticks carry. Its also an opportunity to dispell some of the myths and discuss a few precautions we can take to stay healthy when we are enjoying the outdoors.

Most people have heard of Lyme disease but how many have heard of Human Granulocytic Anaplasmosis or Babesiosis or even Rocky Mountain Spotted fever. Lyme disease has grabbed all the headlines in recent years but ticks can cause other illnesses besides Lyme and not all ticks carry the same diseases. Avoiding serious illness from tick borne diseases is a matter of preventing tick bites when possible, removing ticks as soon as possible, identifying the type of tick, being aware of the symptoms, and getting appropriate medical attention.

Avoiding Tick Bites

There a number of things one can do to avoid tick bites. Some of these things are easy and obvious. Others are more difficult and maybe impractical.

Ticks feed on animal blood. They bite all sorts of animals from tiny little mice to squirrels, deer, and humans. In order to catch their prey, ticks like to perch themselves on bushes or long blades of grass ready to cling on to any passing animal. For this reason one of the best ways to avoid ticks is to avoid areas with deep grass or brush. Trails with heavy brush along the sides are a common place for ticks to place themselves.

Some authorities recommend wearing long sleeve shirts and long pants with the cuffs of the pants tucked inside of boots. The idea here is that the more covered up we are the harder it will be for ticks to find exposed skin to bite into. This may be reasonable in cool weather but in the hot summer months tight fitting long sleeve shirts and pants with heavy boots will quickly lead to overheating and dehydration. Wearing such clothing will also make the wearer miserable and defeat the purpose of spending a day outdoors hiking or playing. Ticks are also very persistent and resourceful. A nymph deer tick is extremely small and given enough time they can find their way through even the heaviest clothing. Unless we are going to wear a space suit outdoors clothing is unlikely to defeat a determined tick.

Some experts have recommended wearing light colored clothing so that ticks will be easier to spot and remove but there have been some studies suggesting that certain types of ticks are actually attracted to lighter colors.

For all these reasons I don't usually recommend dressing to avoid ticks. After living on Long Island for my entire life and spending a lot of it hiking through wooded and grassy areas I have found that after spending the day outdoors, doing a good thorough body check at the end of the day has been a more practical approach that allows me to enjoy outdoor activities while at the same time avoiding tick bourne illnesses.

The best way to do a body check is to take a shower at the end of the day. Before going in the shower do a visual inspection in front of a full length mirror if possible. You obviously won't be able to see everywhere but thats OK for now. Once you finish looking everywhere that you can see go into the shower. Get the hands wet and soapy and then as you soap up the body feel for anything unusual. Soapy hands are very sensitive to small defects. You are feeling for something about the size of a sesame seed that is attached to the skin. Be sure to pay special attention to skin folds and areas with hair since these are locations that ticks seem to prefer but they can attach anywhere so start at the head and systematically work your way down examining every inch of the body right down to the feet. If done properly this shouldn't take much longer than a normal shower.

Most tick borne illnesses can be avoided if the tick is removed within 36 hours of attaching to the skin so make sure you do this at the end of any day when you spend a significant amount of time outdoors.

Tick Removal

There are lots of myths and folk lore about how to remove ticks but the truth is that the best method is the simplest. Removing a tick is not much more complicated than removing a splinter. You want to get as much of the tick out as possible but beyond that there is nothing special about the method. You will need a pair of tweezers and if possible, a small container that you can seal the tick inside of. A glass jar or even a zip lock bag will do.

Once the tick is found the best approach is to grab the tick by the head as close to the skin as possible. Rock the tick gently back and forth while pulling until it breaks free and then seal it in a container. If there are small parts of the tick that remain behind leave them. Do not try to dig them out. Mouth parts from the tick do not carry disease so leaving them in will not increase the risk of contracting Lyme disease or any other illness. They will gradually fall out on their own over time. Trying to dig them out will only damage the surrounding skin and increase the risk of bacterial infection of the skin.

Once the tick is removed clean the area with an antiseptic, make an appointment to see your physician and bring the tick with you.

DO NOT use a lit match, peanut butter, vaseline, or any method other than the one described above to remove the tick. Those methods do not work, they can be dangerous, and they delay tick removal which increases the risk of disease transmission.

Ticks

There are several types of ticks found in North America. In the Northeast the most common types of ticks seen are the Deer Tick, the Brown Dog Tick, the American Dog Tick, and the Lone Star Tick. Each type of tick carries different illnesses so it can be helpful to identify the type of tick one was bitten by in order to know which diseases we need to be alert for.

Tick Bourne Illnesses

Lyme Disease
Lyme disease is probably the most common tick bourne disease that the public is aware of. Unfortunately a lot of the information found in the lay media is sensationalized or incorrect.

Symptoms:
Contrary to popular belief Lyme disease is not a universally disabling disease. Some people who contract lyme disease recover on their own without ever knowing they had an illness. Others are only mildly ill. In nearly all cases a 2-3 week course of oral antibiotics will completely eradicate the illness

Some of the the typical symptoms of early Lyme disease are a rash known as erythema migrans, joint pains, fatigue, chills, headache, and sometimes a fever. The rash is the classic bulls eye rash that usually occurs around the site of the tick bite and may expand and spread over time. While this is the classic presentation more than 30% of patients who get Lyme disease do not get the rash. When diagnosed at this stage oral antibiotics are usually given for 2-3 weeks with complete recovery.

Late stage lyme disease can cause damage to the nervous system, heart, and joints but even these cases usually respond very readily to antibiotics.

Post Lyme Disease syndrome or Chronic Lyme disease as it is sometimes called is a subject of some controversy. There are people who appear to have chronic symptoms and positive Lyme tests but there is little evidence that the symptoms they are experiencing is due to a chronic Lyme disease infection. the confusion arises from the fact that the Lyme disease test is not in fact a test for Lyme disease. What the test is checking for are antibodies to a protein on the lyme disease bacteria. We do not have a test for the bacteria itself. This is a problem because other conditions besides Lyme disease can cause the test to be falsely positive. In addition, if the person had a Lyme disease infection when they were younger and which they were treated for or unaware of, the anitbodies may remain positive many years after they recover from the infection. As a result, a positive Lyme test does not mean the person has an active Lyme Disease infection. The media frequently reports on patients who have difficult and long courses of Lyme disease requiring years of antibiotics but there is little or no evidence that these people actually have a persistent infection with the Lyme disease organism and even less evidence that long courses of antibiotics help with these conditions.

Human Granulocytic Anaplasmosis (HGA)
HGA can cause symptoms such as fever, chills, headache, muscle aches, and fatigue. The symptoms can vary significantly from one patient to another and the similarity of HGA symptoms to other illnesses like influenza can make diagnosis difficult. HGA should be considered in anyone who develops these symptoms within a week or two after being bitten by a deer tick.

Diagnostic testing is not always reliable and often will not be positive untl 7-10 days after infection. Since treatment needs to be started early to be most effective, diagnosis often rests on clinical symptoms and suspicion.

HGA usually responds rapidly to oral antibiotics but it can be a serious illness resulting in death in less than 1% of patients who contract it.

Babesiosis
Babesiosis can also cause flu like symptoms such as fever, chills, sweats, headache, body aches, loss of appetite, and fatigue just like HGA which again makes diagnosis difficult at times. It can be a serious life threatening illness in some individuals especially those with immune system defects, chronic illnesses, or those who have had their splens removed.

Diagnosis requires examination of a blood sample under a microscope or newer tests that can detect Babesiosis DNA.

Treatment requires the use of special antibiotics but requires confirmation of the diagnosis with lab tests

Rocky Mountain Spotted Fever (RMSF)Like the other tick borne illnesses patients with RMSF also have many of the flu like symptoms including fever, chills, headache, and muscle aches but they may also get nausea, vomiting or abdominal pain. The one symptom that sets RMSF apart is a rash. About 90% of patients with RMSF will have a spotted rash but sometimes it does not develop until late in the illness when treatment should have already begun.

RMSF is a serious illness and can be fatal. For treatment to be most effective it must be begun within 5 days of first symptoms but diagnostic tests are often not revealing until 7-10 days into the illness. For this reason as with HGA physicians must rely on symptoms and clinical suspicion when treating patients with RMSF

Erhlichiosis
Erhlichiosis is also accompanied by fever, chills, headache, malaise, and muscle pain but can also be accompanied by abdominal pain and confusion in some patients. A rash may be present but is only seen in about 30% of adults.

As with some of the other tick borne illnesses mentioned above treatment works best if started early but tests often don't turn positive for 7-10 days meaning that physicians must start treatment based on the history, symptoms, and physical exam alone using diagnostic testing only to confirm the diagnosis later on.